两种不同方法修复颊黏膜缺损的临床观察

发布时间：2018-04-05 20:15

本文选题：颊脂垫　切入点：脱细胞真皮基质　出处：《安徽医科大学》2015年硕士论文

【摘要】：背景口腔颌面部软组织可发生不同类型病变,颊黏膜是病灶常见发生处,治疗方法多样,包括药物及手术切除等。而病灶切除后造成的软组织缺损不仅影响美观,同时可因不同程度张口受限而产生咀嚼及言语等功能障碍。临床上对颊黏膜软组织缺损的重建包括直接拉拢缝合、黏膜转移、自体颊脂垫移植[1]、中厚皮片移植和血管吻合游离皮瓣移植等方法。近年来脱细胞真皮基质(acellular dermal matrix.ADM)已被临床工作者大量应用,在修补软组织缺损方面取得了理想的手术效果[2]。ADM是由同种或异种真皮组织经过特殊处理,去除其细胞成分后得到的一种真皮替代品。同种ADM来源于死刑犯,由于伦理方面的限制,使用日益见少;现临床上以异种ADM为主,其使用哺乳动物(如牛、猪等)的皮肤制备而成,用于修复口腔黏膜缺损是安全和有效的,是一种较为理想的真皮替代物。目的观察并比较自体带蒂颊脂垫瓣(pedicle buccal fat pad flap,PBFPF)与ADM在修复颊黏膜缺损中的临床效果。方法选取我院口腔颌面外科2012年12月~2013年12月因口腔颊部良恶性肿瘤需手术治疗者46例,其中男25例,女21例。所有病例中乳头状瘤7例、脉管畸形14例、脂肪瘤4例、多形性腺瘤9例、白斑2例、黏膜下纤维化2例、创伤性溃疡1例、未浸及肌层鳞癌3例(T1N0M0期1例、T2N0M0期2例,UICC 2010版),未浸及肌层低度恶性黏液表皮样癌4例(T1N0M0期,UICC 2010版)。面积2.3 cm×3.7 cm~4.2 cm×5.1 cm,均不能直接拉拢缝合。将46例患者随机分为2组,一组使用PBFPF修复手术后颊黏膜缺损,另一组在切除术区病损后,表面缝盖ADM。观察并记录两组患者术前及术后1~6个月最大开口度(maximum opening degree,MMO)、手术修复时间等并结合患者满意度进行统计学分析。结果两组组织瓣术后均成活,未见明显血肿、感染、局部坏死、过度瘢痕及面神经受损等。PBFPF组术后1~3天MMO均低于ADM组,差异均有统计学意义(P0.05),而术后1周至6个月两组MMO相比差异无统计学意义;两者手术修复时间相比,差异有统计学意义(P0.05);比较两组患者满意度,差异无统计学意义。结论两种方法均可满足颊部良性肿瘤及口腔中后部T2N0M0恶性肿瘤初次治疗要求,ADM使用更加灵活。但受病例数限制,对于首次切除T2N0M0及以下恶性肿瘤首选ADM修复是否合适,还需进一步研究。
[Abstract]:Background different types of soft tissue lesions can occur in oral and maxillofacial regions, buccal mucosa is the common location of lesions, and there are various treatment methods, including drugs and surgical excision.The soft tissue defects caused by excision not only affect the beauty, but also cause chewing and speech disorders due to the limited opening of mouth.Clinical reconstruction of buccal mucosal soft tissue defects includes direct suture, mucosal metastasis, buccal fat pad autograft, moderate thickness skin graft and free vascular anastomosis flap transplantation.Acellular dermal matrix. ADM has been widely used by clinical workers in recent years. It has achieved ideal surgical results in repairing soft tissue defects [2] .ADM is specially treated by allogeneic or xenogeneic dermal tissue.A dermal substitute obtained by removing its cellular components.ADM of the same species, derived from death row prisoners, is used less and less because of ethical restrictions. Now it is mainly heterologous ADM, which is prepared from the skin of mammals (such as cattle, pigs, etc.).It is safe and effective to repair oral mucosal defects and is an ideal dermal substitute.Objective to observe and compare the clinical effects of buccal buccal pad flapfps and ADM in repairing buccal mucosal defects.Methods from December 2012 to December 2013, 46 patients (25 males and 21 females) with benign and malignant tumors of buccal region in our hospital were selected.There were 7 cases of papilloma, 14 cases of vascular malformation, 4 cases of lipoma, 9 cases of pleomorphic adenoma, 2 cases of leukoplakia, 2 cases of submucosal fibrosis and 1 case of traumatic ulcer.There were 3 cases of uninfiltrated myosquous squamous cell carcinoma (T1N0M0), 1 case of T1N0M0 stage and 2 cases of T2N0M0 stage (UICC 2010), and 4 cases of myometrium low grade malignant mucoepidermoid carcinoma (MECC) were diagnosed as T1N0M0 stage (UICC 2010).The area was 2. 3 cm 脳 3. 7 cm~4.2 cm 脳 5. 1 cm, all of them could not be closed and sutured directly.46 patients were randomly divided into two groups: one group was treated with PBFPF to repair buccal mucosal defect, the other group was treated with PBFPF.The maximum opening degree before operation and 1 ~ 6 months after operation were observed and recorded, and the time of operation and repair were analyzed statistically.Results there was no obvious hematoma, infection, local necrosis, hyperscar and facial nerve injury in both groups. The MMO of PBFPF group was lower than that of ADM group on the 1st and 3rd day after operation.The difference was statistically significant (P 0.05), but there was no significant difference in MMO between the two groups from 1 week to 6 months after operation, there was significant difference in the time of operation and repair between the two groups (P 0.05), and there was no significant difference between the two groups in patient satisfaction.Conclusion both methods can meet the primary treatment requirements of benign buccal tumors and T2N0M0 tumors in the middle and posterior parts of the oral cavity.However, due to the limitation of the number of cases, it is necessary to further study whether the ADM repair is the first choice for the first excision of T2N0M0 and the following malignant tumors.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R782.2

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